by Christopher Piehler

In a recent Web poll on, I posed the question, “Which appliance do your patients ask for the most?” Now, this was not a scientifically formulated survey, so we should all take these numbers with several shakers of salt, but 71% of those who responded said that patients asked most for aesthetic labial brackets; 26% of respondents said their highest level of demand was for clear aligners; and the remaining 3% replied that their patients were most interested in lingual brackets.

Initially, I was surprised at these numbers. I had assumed that, without knowing the full details of their diagnosis, most patients would request the least visible types of treatment. So why would nearly three quarters of patients specifically ask for labial braces? I think there are several reasons.

First, there is the added expense. In looking for my own orthodontist, I found that lingual braces and aligners cost significantly more than “regular” braces. It also may be that the less visible types of treatment lack, well, visibility, so that patients may not have heard of these alternatives before they come to the orthodontist. Orthodontic companies have not been as aggressive as, say, the pharmaceutical industry in reaching out directly to patients with “ask your doctor about …” ads. Then again, the overwhelming majority of orthodontists with whom I have worked are eager to let their patients know their options.

The third (and my favorite) explanation for the poll numbers is the popularity of grills—and I don’t mean barbecues. Wikipedia calls a grill a “cosmetic dental metal apparatus featuring silver, gold, or platinum caps with diamond inlays (usually princess-cut diamonds) jewelled to be worn over the teeth.” Grills were brought into the mainstream by the rapper Nelly, whose song “Grillz” was a hit in 2005, and whose video shows a variety of mouth jewelry. Others who have sported grills are rockers Korn, Marilyn Manson, and Avenged Sevenfold—all of whom are popular among the preteens and teens who compose the majority of orthodontic patients. This is a rare moment for orthodontics, when pop culture has made a mouthful of metal something to seek out. So while you may prescribe braces for many sound medical reasons, your patients will want them for the best reason they can imagine: because they look cool.